Wiki medicare deductible/supplement payments

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lindam@caricures.com

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We have a difference of opinion - looking for the correct information or where to look for it. If a patient has Medicare Primary and PR is say $50, claim send to supplement/2nd insurance and they make a payment of $25 with PR 0.00 = are we allowed to bill the patient for the other $25 that Medicare originally set as patient responsibility.
 
lindam@caricures.com said:
We have a difference of opinion - looking for the correct information or where to look for it. If a patient has Medicare Primary and PR is say $50, claim send to supplement/2nd insurance and they make a payment of $25 with PR 0.00 = are we allowed to bill the patient for the other $25 that Medicare originally set as patient responsibility.
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Is the secondary a commercial insurance policy or Medicaid?

Generally, if the secondary is a commercial insurance policy, you could bill the other $25 to the patient. The patient's responsibility after Medicare was $50. Their secondary insurance picked up $25 of that. The other $25 is still remaining.

If the patient is dual eligible and the secondary is Medicaid, then there should have been a remark code indicating that the primary payment exceeded the Medicaid allowable amount. You wouldn't bill the patient in that circumstance when the secondary plan was Medicaid.

(There could be other exceptions to the rule that I'm not thinking of offhand.)
 
lindam@caricures.com said:
Not Medicaid.
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Okay, this makes more sense to me now that I'm seeing an example EOB.

After Medicare, there was $65.47 deductible and $19.15 coinsurance.

The supplement from Capital Blue Cross picked up the $19.15 coinsurance. The patient still owes the $65.47 deductible.

If you look at Capital Blue Cross's Medicare Supplement booklet for members, you'll see that the plans they offer only cover the Part B coinsurance, not the Part B deductible. (Unless the patient had Medicare prior to 2020 and was grandfathered into a C or F plan.)


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